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Anthony Bray, MD, Doctor

Category: Health

Satisfied Customers: 7458

Experience: 14 years as clinician in the field of Family Practice

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I have Pelvic Floor dysfunction and pain in my genitals which

Resolved Question:

I have Pelvic Floor dysfunction and pain in my genitals which has caused alot of pain and depression for me. This has been going on in my life for 18 years now. I took paxil 15 years ago and it had a placebo effect on me and it seemed to work. I then continued to have pain, adjusting my posture and such over time, and now I feel weak. I have taken Klonopin and Zoloft together now for 18 months. 100 mg Zoloft, 1.25 mg Klonopin per day, but I am still so anxious yet tired. Now if I dont take the Klonopin, my pain and anxiety are extremely increased. I get really hot and cold and miserable. The klonopin helps, but not as much as it used to. Is it that I am on too low of a dose, or what to do. I have seen two psychiatrists who dont know what to do with me. I am afraid of the Klonopin, but its the only thing that helps me feel somewhat normal, although I can feel tired on it. I also do twice a week CBT and Physical therapy, but the pain and anxiety have really limited my life. Is there any suggestions you can make to help me?

Anthony Bray, MD :You may benefit from a medicine for chronic neurological pain such as Lyrica or Neurontin...

Anthony Bray, MD :A prescription anti- inflammatory might be tried if not already done...Celebrex / Lodine/ Mobic as Rx options ( I realize that this may have been tried in your 18 years but just covering a base here--- it depends in the mechanism of pain...

Anthony Bray, MD :Over the counter options such as Aleve or Advil might have benefit if any inflammatory mechanism contributes to your pain...

Anthony Bray, MD :Ultram may be a helpful pain relief option that may be additive in effect to other pain relief mechanisms .... It is a partial opioid receptor agonist but is less of high concern than narcotics for chronic pain treatment...

Anthony Bray, MD :Tylenol has unique mild pain relief mechanism and is often used in combination ( example Ultram is combined with Tylenol ( acetaminophen ) in the combination of Ultracet...

Anthony Bray, MD :Further evaluation and help per a Urologist may be helpful for your diagnosis ....

Anthony Bray, MD :I hope this information is helpful for you! Let me know if you have further questions/ information/ discussion and I will be happy to get back with you!

Anthony Bray, MD :If my answers have been helpful and to your satisfaction then please remember to leave positive feedback . That would be very much appreciated!

Anthony Bray, MD :Thank you and best regards!

Anthony Bray, MD :Anthony Bray MD

Customer:

Dr. Bray,

Customer:

Thank you for your reply. I have been through the whole urologist thing, and it has basically been diagnosed as my anxiety and chronic holding of my pelvic floor, and has become an entire body tensing thing. I have taken many anti-inflammatory medications, but realize that my pain is caused by anxiety, but I am anxious in taking meds. Can Klonopin be used effectively for a long time? I have read so many scary things on the internet about Benzo's and that some can use it long term and others keep increasing and go through massive withdrawal. If anxiety is the main cause of my condition, should I continue the klonopin at a higher dosage? My Pdoc is not very good and didnt knew the benzo conversions of 10mg valium = .5 mg klonopin, so I didnt know where to turn and found your sight and thought I would see if I could get some help

Hello -- yes if your condition is due to anxiety then I would advise to stay on the Klonapin plus the antidepressant . Thus should be a good combination for you to continue. As long as taken CORRECTLY -- chronic use of Klonapin should be quite safe (TREMENDOUS DANGER IS DOR THISE WHO TAKE ABOVE THEIR DOSE--- this class especially in combination with narcotics>> people may double dose and overdose for example !!!

So that is my main warning with regard to Klonapin!! If you really needed increase then this might be titrated up but I would only resort to upward titration very reluctantly ... It is true that you may develop a degree of tolerance for benzodiazepine class but they generally will not lose effectiveness to treat anxiety( effect may attenuate some with time but it would still be mostly effective ...

The 1.25 mg if Klonapin is a fair dose-- possible to increase but Klonapin tends to be very sedating... 0.5 Am and 1.0 mg at bedtime might be worth try for you though....

The option of Lyrica or Neurontin work on CNS to decrease processing of pain and also may have benefit toward anxiety.... Combining one if these might be more effective as it would add a separate mechanism of action... These may also be sedating though and the meds being too sedating for you would be my major concern...

I hope this is helpful for you!! Let me know if you have further questions or discussion and I will be happy to her back with you!!

Yes my fear is anxiolotic effect sans the sedation. I do appreciate your time and will rate you extremely high. Would there be any better option with anxiety, or is sedation the only way to achieve desired results?

Well there are other potential options for generalized anxiety such as Buspar for example...

If you had panic attacks this would typically be less effective. It would need to be in your system for weeks to reach maximum effect ( similar to anti- depressant in this regard)

If you anxiety were reasonably controlled on the regimen you are in I would be reluctant to try and change to Buspar though ...

Yes-- pretty much true that anxiety treatment is associated with sedating effect. No treatment comes to mind really where this would not be true ( well Cymbalta and similar medication such as Effexor would not be sedating but you reported that you tried this and did not do well)

Other options are available -- I believe you mentioned some that you have tried without good results--- Seroquel/ Risperdol/ other anti-psychotic meds and mood stabilizer meds more often used for schizophrenia or bipolar disorder ....

I think your current meds are good choices vs the issues of your anxiety and chronic pain.. I think that perhaps fine tuning the dose such as mild increase of Klonapin or adding another agent to help potentially vs chronic pain.. ( I would favor considering Lyrica for example as a possible next step)

I would be reluctant to dramatically change your regimen that seems to have significant benefit vs not being in these meds....

I think fine tuning to aim for greater benefit makes the most sense.

There are options beyond the specifics that I have listed but other options would be similar in effect...

I hope this helps you!! Let me know if you have further questions or concerns!!

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

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